Today on the podcast, we discuss Midlines. This is the first of two parts. In a week, I will interview Rory Spiegel on the topic, so send me your thoughts and questions in anticipation of that episode.
What the Heck is a Midline?
a 8-25 cm catheter that is placed in the arm and doesn't extend past the shoulder
Why Ultrasound-Guided IVs Suck?
- They aren't long enough 
- Nearly 1/2 of them are dislodged in 24 hrs [Ann Emerg Med 1999;34(6):711]
- Another study demonstrating they do not last [AJEM 2010;28:1]
- Vessel Depth and Catheter Depth are the key to longevity [AJEM 2011 Fields et al.]
- Need 2.75 cm in the vessel for good reliability [https://doi.org/10.1016/j.annemergmed.2019.11.013]
- Midlines are better for avoidance of infections
Which Midlines Do We Use?
10 cm Midline
20 cm Midline
I take no money from any of these folks
Video of the Dual-Lumen Midline Placement
Safety of Midlines for
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Now on to the Podcast…
- EMCrit 292 – IV T3 for Myxedema Coma, A Different Take with Eve Bloomgarden - February 23, 2021
- EMCrit 291 – For Frak's Sake, Ketamine is at least as Hemodynamically Stable as Etomidate! - February 9, 2021
- EMCrit 290 – Decompensated Hypothyroidism and Myxedema with Dr. Arti Bhan - January 23, 2021